Episodic memory boosting in older adults: exploring the association of encoding strategies and physical activity

Background: Contextual memory is susceptible to the effects of aging and its impairment compromises episodic memories and quality of life in older adults.

Objective: Compare the effects of cognitive support on incidental contextual memory free recall and recognition with a naturalistic experimental paradigm and explore the association of encoding strategies and physical activity on memory improvement.

Methods: Subjects (≥60 years, n?=?52) were assigned to one of two encoding conditions for the contextual memory task: with or without an incidental associative instruction to encourage association of an item to its spatial context. Immediate free recall and recognition tests were run to assess the encoding instruction efficiency. The association of memory performance and physical activity was analyzed using the scores on the International Physical Activity Questionnaire (IPAQ) to subdivide each experimental group into Low IPAQ (below median) and High IPAQ (above median) subgroups.

Results: The associative encoding instruction increased contextual memory free recall and recognition, with greater effects on free recall. The most robust associations between physical activity and contextual memory were also seen on free recall, in which higher levels of physical activity corresponded to increased baseline performance (non-associative encoding condition) and greater improvement of memory by the encoding support (associative encoding condition).

Conclusion: Cognitive support at encoding can improve contextual memory free recall and recognition, suggesting they are prone to rehabilitation. Moreover, higher physical activity levels were positively associated with encoding strategies on contextual memory improvement, increasing the availability of latent process-based components of the cognitive reserve.     

An elderly patient with Alzheimer’s disease,normal pressure hydrocephalus and traumatic brain injury: presented with behavioral symptoms similar to behavioral variant frontotemporal dementia

Objective: Traumatic brain injury (TBI) is nondegenerative insult to brain from external mechanical forces. It may cause cognitive impairment, psychological problems in the long period. Besides traumatic brain injury also induces neuroinflammation and neurodegeneration process, and increases risk of dementia. It may cause various psychiatric complications such as depression, posttraumatic stress disorder, generalized anxiety disorder, and other cognitive and behavioral sequela according to site of involvement in the brain.

Methods: We report a patient who has behavioral symptoms, amnesia and gait apraxy after TBI. Patient's symptoms were similar to behavioral variant Frontotemporal Dementia (bv FTD).

Results: After detailed neurocognitive and radiologic evaluation he was diagnosed with Normal Pressure Hydrocephalus (NPH), and Alzheimer's Disease (AD) following TBI.

Conclusion: Comprehensive geriatric assessment, including detailed radiological examinations, if it is necessary, is recommended for the optimum management of elderly patients with cognitive and psychosocial problems in order to avoid misdiagnosis and inappropriate treatment.     

Memory and affective changes during the antepartum: A narrative review and integrative hypothesis

Introduction and objectives: Many women report diminished memory function during the second or third trimesters of pregnancy, but objective neuropsychological tests often fail to show any decrement in performance. The present paper systematically reviews published studies that have investigated this phenomenon over the past 25 years and considers newer studies showing that affective changes occur during gestation in a subset of pregnant women.

Method: A systematic search was conducted to identify articles relevant to pregnancy and memory function. Articles published since 1990 that included a nonpregnant comparison group were retained for review.

Results: A literature review of studies using objective memory testing suggests that a mild antepartum decline in explicit verbal recall occurs in some women. There is little empirical support for objective changes in semantic or implicit memory during pregnancy. Findings for working memory are mixed, with evidence supporting both decrements and enhancements. Inconsistencies in the literature potentially reflect a moderating influence of pregnancy-linked depressive affect on cognitive performance, not simply domain specificity, as previously suggested.

Conclusions: Diminished memory function may occur in a specific subset of pregnant women who display depressive symptoms associated with pregnancy.     

To what extent is subjective well-being in late adulthood related to subjective and objective memory functioning? Five-year cross-lagged panel analyses

Background: Population aging motivated a focus in contemporary research on factors, e.g. cognitive functioning, that contribute to ‘aging well.’ However, something that has been overlooked is relation between memory functioning, determined by objective tests as well as subjective memory ratings, and subjective well-being (SWB).

Objectives: The aim of the present study was to investigate cross-sectional and longitudinal (cross-lagged) relationships between episodic memory (both subjective and objective) and SWB.

Method: A total of 586 older individuals (60–90 years) were assessed on multiple measures of the targeted constructs at baseline (Time 1) as part of the Betula cohort study. Five years later (Time 2), 354 of the participants returned for follow-up measurements and were included in cross-lagged panel analyses.

Results: As expected, objective memory and subjective memory showed a pattern of cross-sectional age deficits and a mean level longitudinal decline was observed for objective memory. By contrast, SWB showed stable mean levels both across age and time. No cross-sectional or cross-lagged associations were observed between SWB and objective memory, whereas subjective memory and SWB showed a cross-sectional association.

Conclusion: The results underscore that successful aging is a multifaceted construct with no or only weak associations between the investigated components. However, SWB and rate of change at the individual level should be considered to define successful aging.     

Smell your memories: Positive effect of odor exposure on recent and remote autobiographical memories in Alzheimer’s disease

Introduction: There is a burgeoning interest in the effects of odor exposure on autobiographical memory in Alzheimer’s disease (AD). We pursued this line of research by assessing the effect of odor exposure on the retrieval of recent and remote memories in AD.

Method: Twenty-six patients with mild AD and 28 controls were tested in two conditions: with and without odor exposure. In each condition, participants were invited to retrieve two childhood memories, two adulthood memories, and two recent memories.

Results: Analysis showed that AD patients produced a higher number of and more specific childhood memories, adulthood memories, and recent memories after odor exposure than without odor.

Discussion: These findings demonstrate how odor exposure may alleviate anterograde and retrograde amnesia, at least when considering the ability of patients with mild AD to retrieve few recent or remote memories.     

Measuring emotion perception following traumatic brain injury: The Complex Audio Visual Emotion Assessment Task (CAVEAT)

Introduction: While emotion recognition difficulties in moderate-severe TBI are well established, the standard measures of emotion recognition significantly limit the conclusions which can be drawn regarding real-life deficits. Two studies report on the development of CAVEAT, a new measure of emotion recognition that attempts to overcome these limitations.

Method: These studies were designed to establish CAVEAT's psychometric properties by examining performance of a TBI group and matched controls in order to provide estimates of its reliability and validity (study 1), and to compare performance of the TBI and control groups on a subgroup of emotions from the CAVEAT that represented the six basic emotions used in conventional emotion research (study 2). Thirty-two participants with TBI and 32 matched controls (study 1) and 16 participants with TBI and 12 matched controls (study 2) participated in this study.

Results: CAVEAT demonstrated high construct validity and internal consistency. Performance on the subgroup of “basic” six emotions was largely similar to the rates reported in the literature.

Conclusions: These findings provided some evidence for the psychometric properties of CAVEAT, indicating that it can be used as a clinical test for assessing emotion recognition in people with moderate-severe TBI.     

The lived experience of behaviours of concern: A qualitative study of men with traumatic brain injury

Background and aims: Behaviours of Concern (BoC) are a debilitating consequence of Traumatic Brain Injury (TBI). Whilst perspectives of clinicians, carers and family members on BoC have been previously explored, few qualitative studies have included individuals with TBI. The aim of this study was to explore the lived experience of BoC in individuals with TBI, their close others and clinicians.

Method: Eleven males with TBI and BoC were recruited and 25 semi-structured qualitative interviews were conducted (9 individuals with TBI, 9 close others, 7 clinicians). A six-phase thematic analysis approach was utilised.

Results: Frequent and persistent BoC were reported and the key themes identified included the brain injury, control, environment, mood, identity, social relationships, and meaningful participation. Whilst the brain injury contributed to BoC in all cases, the way the other themes manifested and interacted was variable.

Conclusions: This study enriches our understanding of factors associated with BoC. Themes emerging from this study will inform interventions designed to reduce BoC and ultimately maximise quality of life for individuals with TBI and their families.     

A study on the association of psychiatric diagnoses and childhood adversities with suicide risk

Background: In addition to psychiatric disorders, childhood adversities may increase the risk of suicidal behavior. In previous studies, the effects of clinical co-morbidity and overlap of childhood adversities has rarely been taken into account.

Aim: The study aims to search associations of psychiatric diagnoses and childhood adversities and trauma (CAT) with suicide risk.

Methods: Altogether 415 adult patients attending primary and psychiatric outpatient care filled in the Trauma and Distress Scale, including assessment of five core CAT domains (emotional, physical and sexual abuse, and emotional and physical neglect). The study patients’ current psychiatric disorders and suicide risk were assessed by the Mini International Neuropsychiatric Interview.

Results: Age, poor perceived health, poor social support, current psychiatric treatment, all psychiatric disorders, except hypomania, emotional and physical abuse, and emotional neglect did associate significantly with suicide risk. Number of psychiatric disorders and CAT domains had dose-dependent effects on suicide risk. In multivariate analysis, current psychiatric treatment, current and life-time major depression, social phobia, alcohol, and drug dependency, as well as emotional abuse had direct associations with suicide risk. In females, manic disorders and drug dependence, and in males, dysthymia, social phobia, and emotional abuse associated with suicide risk.

Conclusions: Psychiatric disorders and most CAT domains associate with suicide risk. However, when the effect of co-morbidity and overlap of CAT domains is controlled, major depression, social phobia, alcohol, and drug dependency and emotional abuse seem to increase the risk of suicide. The risk profile varies between the genders.     

Effect of activity-based mirror therapy on lower limb motor-recovery and gait in stroke: A randomised controlled trial

Objective: To determine the effect of activity-based mirror therapy (MT) on motor recovery and gait in chronic poststroke hemiparetic subjects.

Design: A randomised, controlled, assessor-blinded trial.

Setting: Rehabilitation institute.

Participants: Thirty-six chronic poststroke (15.89?±?9.01 months) hemiparetic subjects (age: 46.44?±?7.89 years, 30 men and functional ambulation classification of median level 3).

Interventions: Activity-based MT comprised movements such as ball-rolling, rocker-board, and pedalling. The activities were provided on the less-affected side in front of the mirror while hiding the affected limb. The movement of the less-affected lower limb was projected as over the affected limb. Conventional motor therapy based on neurophysiological approaches was also provided to the experimental group. The control group received only conventional management.

Main outcome measures: Brunnstrom recovery stages (BRS), Fugl-Meyer assessment lower extremity (FMA-LE), Rivermead visual gait assessment (RVGA), and 10-metre walk test (10-MWT).

Results: Postintervention, the experimental group exhibited significant and favourable changes for FMA-LE (mean difference?=?3.29, 95% CI?=?1.23–5.35, p?=?.003) and RVGA (mean difference?=?5.41, 95% CI?=?1.12–9.71, p?=?.015) in comparison to the control group. No considerable changes were observed on 10-MWT.

Conclusions: Activity-based MT facilitates motor recovery of the lower limb as well as reduces gait deviations among chronic poststroke hemiparetic subjects.     

A how-to guide to aphasia services: celebrating Professor Linda Worrall’s contribution to the field

Background: This article recognises Professor Linda Worrall’s contribution to aphasiology and discusses research themes which have grown from her work.

Aims: To review, summarise, and discuss literature relating to four themes which have emerged from the work of Professor Worrall: (1) Research capacity building; (2) Implementation of research evidence in clinical practice; (3) Meaningful outcome measurement; and (4) Improvement of psychological and emotional outcomes.

Main contribution: A review of the literature, with examples of practical applications.

Conclusions: The work of Professor Worrall has greatly influenced the field of aphasia; her legacy is the research capacity she has built in Australia and around the world.     

French translation and validation of a fragile X syndrome screening checklist

Background: Fragile X syndrome (FXS) is the most common cause of inherited intellectual disability among men. This syndrome is frequently underdiagnosed in adults. The aim of this study was to develop and validate a French translation of the screening checklist Fragiele-X screeningslijst.

Method: The validation sample for the translated checklist included 22 pairs of men between the ages of 18 and 52, matched by age and degree of intellectual impairment.

Results: The translated checklist achieved coefficients of 0.92 for internal consistency, 0.90 for test-retest reliability and 0.65 for inter-rater reliability. These psychometric properties are commensurate with those of the original checklist.

Conclusion: Therefore, the translated checklist developed in this study can be considered a valid screening instrument for the detection of FXS in men with intellectual disabilities.

Abbreviations: FXS: fragile X syndrome; FMR1: fragile X mental retardation 1 (gene)     

Impaired lexical selection and fluency in post-stroke aphasia

Background: Deficits in fluent language production are a hallmark of aphasia and may arise from impairments at different levels in the language system. It has been proposed that difficulty resolving lexical competition contributes to fluency deficits.

Aims: The present study tested this hypothesis in a novel way: by examining whether narrative speech production fluency is associated with difficulty resolving lexical competition in spoken word recognition as measured by sensitivity to phonological neighborhood density.

Methods & Procedures: Nineteen participants with aphasia and 15 neurologically intact older adults identified spoken words that varied in phonological neighborhood density and were presented in moderate noise.

Outcomes & Results: Neurologically intact participants exhibited the standard inhibitory effect of phonological neighborhood density on response times: slower recognition of spoken words from denser neighborhoods. Among participants with aphasia, the inhibitory effect of phonological neighborhood density (less accurate recognition of spoken words from denser neighborhoods) was smaller for participants with greater fluency. The neighborhood effect was larger for participants with greater receptive vocabulary knowledge, indicating that the fluency effect was not a result of general lexical deficits.

Conclusions: These results are consistent with the hypothesis that impaired lexical selection is a contributing factor in fluency deficits in poststroke aphasia.     

Moderators,mediators and nonspecific predictors of outcome after cognitive rehabilitation of executive functions in a randomised controlled trial

Moderators, mediators and nonspecific predictors of treatment after cognitive rehabilitation of executive functions in a randomised controlled trial

Objective: To explore moderators, mediators and nonspecific predictors of executive functioning after cognitive rehabilitation in a randomised controlled trial, comparing Goal Management Training (GMT) with an active psycho-educative control-intervention, in patients with chronic acquired brain injury.

Methods: Seventy patients with executive dysfunction were randomly allocated to GMT (n?=?33) or control (n?=?37). Outcome measures were established by factor-analysis and included cognitive executive complaints, emotional dysregulation and psychological distress.

Results: Higher age and IQ emerged as nonspecific predictors. Verbal memory and planning ability at baseline moderated cognitive executive complaints, while planning ability at six-month follow-up mediated all three outcome measures. Inhibitory cognitive control emerged as a unique GMT specific mediator. A general pattern regardless of intervention was identified; higher levels of self-reported cognitive—and executive–symptoms of emotional dysregulation and psychological distress at six-month follow-up mediated less improvement across outcome factors.

Conclusions: The majority of treatment effects were nonspecific to intervention, probably underscoring the variables’ general contribution to outcome of cognitive rehabilitation interventions. Interventions targeting specific cognitive domains, such as attention or working memory, need to take into account the patients’ overall cognitive and emotional self-perceived functioning. Future studies should investigate the identified predictors further, and also consider other predictor candidates.     

Cultural differences in categorical memory errors persist with age

Objectives: This cross-sectional experiment examined the influence of aging on cross-cultural differences in memory errors. Previous research revealed that Americans committed more categorical memory errors than Turks; we tested whether the cognitive constraints associated with aging impacted the pattern of memory errors across cultures. Furthermore, older adults are vulnerable to memory errors for semantically-related information, and we assessed whether this tendency occurs across cultures.

Methods: Younger and older adults from the US and Turkey studied word pairs, with some pairs sharing a categorical relationship and some unrelated. Participants then completed a cued recall test, generating the word that was paired with the first. These responses were scored for correct responses or different types of errors, including categorical and semantic.

Results: The tendency for Americans to commit more categorical memory errors emerged for both younger and older adults. In addition, older adults across cultures committed more memory errors, and these were for semantically-related information (including both categorical and other types of semantic errors).

Conclusion: Heightened vulnerability to memory errors with age extends across cultural groups, and Americans’ proneness to commit categorical memory errors occurs across ages. The findings indicate some robustness in the ways that age and culture influence memory errors.     

‘It is nothing more than a senior moment’: the moderating role of subjective age in the effect of change in memory on self-rated memory

Objective: The association between memory performance and self-rated memory is yet to be understood. More specifically, little is known about the factors that lie at the base of self-evaluations of memory in relation to actual changes in memory. In this study, we suggest that subjective age modifies the effect of objective change in memory on self-rated memory.

Method: We used two waves of the Health and Retirement Study (N = 4624) to examine whether subjective age moderates the effect of experienced changes in memory between T1 and T2 on self-rated memory at T2.

Results: Our results suggest that subjective age is a significant moderator of the effect of change in memory on self-rated memory. The effect is weaker among those with younger subjective age, and stronger for those with older subjective age.

Conclusion: While preserving a young subjective age is usually considered an adaptive strategy, it also has potential negative effects, masking changes in memory performance.     

A Note on the “One Case per Stagger Position” Character of Common Multiple-Baseline Intervention Designs

Purpose: To overcome the constraint of common multiple-baseline designs that only one case per stagger position is permitted.

Methods: Three alternative strategies for assigning more than one case to each stagger position are examined.

Results: The three recommended strategies achieve the objective while maintaining the study’s internal and statistical-conclusion validities.

Conclusions: ExPRT, a freely available Excel-based randomization-test package, can be used to assist in both the design and statistical analysis associated with each of the strategies.     

Intensive cognitive rehabilitation therapy for chronic traumatic brain injury: a case study of neural correlates of functional improvement

Background: Some four million Americans are living with chronic disability related to traumatic brain injury (TBI). Yet, very little research has investigated training-induced neuroplasticity over many hours of treatment well into the chronic stage for the most commonly impaired functions (attention, executive functions (EFs), and prospective memory (PM)).

Aims: The purpose of the present study was to investigate whether a 30-h course of intensive evidence-based treatments of attention, EFs, and PM would show behavioural gains and associated brain structural and/or functional changes in an individual well into the chronic phase of recovery from TBI.

Methods & Procedures: An A-B single-participant quasi-experimental design with 1 month post-treatment follow-up was employed for cognitive rehabilitation of a 54-year-old man, 7.5 years after severe TBI. After an initial 4-week pre-treatment baseline phase, 30 hours of therapy was provided over 3 weeks, targeting attention, PM, and EFs, with follow-up testing at 1-month post-treatment. Treatments (selected from evidence-based practice guidelines) consisted of attention process training, metacognitive strategy instruction, and PM training. Neuroimaging (auditory oddball paradigm, resting state, and diffusion tensor imaging) was conducted weekly from the end of the A-phase, through the end of the B-phase, and then at 1-month follow-up.

Outcomes & Results: Results demonstrated gains to behavioural and quality of life measures for attention and EFs, with evidence of associated structural and functional neuroplasticity. There was no evidence of change to PM skills.

Conclusions: Intensive evidence-based treatment of attention and EFs improved functioning and quality of life in an individual well into the chronic phase of TBI, and may be associated with structural and functional neuroplasticity.     

Outcome instruments in moderate-to-severe adult traumatic brain injury: recommendations for use in psychosocial research

Background: Traumatic brain injury (TBI) can reduce psychosocial functioning, causing relationship, family, and employment difficulties. The present study by Moving Ahead: Centre for Research Excellence (CRE) in Brain Recovery aimed to identify a set of adult outcome instruments for moderate-to-severe TBI psychosocial research.

Procedure: A review of 115 instruments (identified through nomination, literature search, and international expert opinion) was conducted over a 15-month period. Eleven psychosocial areas were examined: Global Outcome, Communication, Social Cognition, Behavioural and Executive Function, Other Neuropsychological Functioning, Psychological Status, TBI-related Symptoms, Activities and Participation, Support and Relationships, Sense of Self, and Health-related Quality of Life. Individual instruments were considered against selection guidelines, and specific measures that best met the guidelines were identified as core (common across all studies), supplemental (dependent on study type) or emerging.

Results: The final recommendations, organised in accordance with the World Health Organisation’s International Classification of Functioning taxonomy, comprised 56 instruments for use in early recovery, outcome, and intervention studies.

Conclusion: These recommendations provide a coherent framework along with identified outcome instruments to guide psychosocial research in moderate-to-severe TBI. Adherence to the recommendations will enable data-pooling and comparison across studies and research settings facilitating consistent measurement across the lifespan.     

Exploring dimensions of social support and resilience when providing care at the end of life: a qualitative study

Background: Research shows that formal and informal social support can facilitate resilience in carers. There is a paucity of research exploring social support and resilience amongst recently bereaved informal carers.

Aim: To examine how the presence or absence of distinct dimensions of social support facilitate or hinder resilience in recently bereaved informal carers.

Participants: 44 bereaved carers, who had been identified by GP as ‘main carer’ of someone recently deceased (3–12 months), aged between 38 and 87 years old (mean= 67).

Methods: Thematic analysis then the Ecological Framework of Resilience as an organisational tool to develop overarching themes in the data. We used the Sherbourne and Stewart model to identify social support that was lacking as well as social support that was present.

Results: A range of social support types were identified. There was an emphasis on the importance of relationships with both health professionals and family members, including the care recipient. However, social support was not necessary for resilience if the participant had other resources.

Conclusions: Social support for carers providing end of life care is almost exclusively based around end of life care ‘work’. In comparison to other research our study suggests that relationships with family and health professionals are paramount. Multidimensional support is needed for carers to enhance their resilience.     

Estimation of skeletal muscle mass in patients with spinocerebellar ataxia type 3 and 10

Background: Neurodegenerative diseases may progress to a level in which patients present spontaneous weight loss, resulting in increased falls and functional disabilities when the disease is associated with muscle mass depletion.

Objective: Evaluate the muscle compartment in patients presenting spinocerebellar ataxia (SCA) type 3 and 10.

Methods: Forty-six patients presenting SCA type 3 and 10 were assessed and 76 volunteers were selected to the control group. In order to evaluate the muscle compartment, muscle mass anthropometric measurements were assessed and total skeletal muscle mass calculated through a predictive equation.

Results: Women with SCA3 presented greater weight loss and muscle mass reduction compared to those with SCA10 and the control group. Among the predictive measurements, calf muscle circumference showed a more significant correlation with total skeletal muscle mass (p = 0.718).

Conclusion: Patients presenting both types of ataxia did not show severe depletion in their nutritional status; however, those with SCA3 displayed greater weight loss and muscle mass reduction compared to the SCA10 group.